Provider Demographics
NPI:1659080216
Name:FAKHOURY, TINA (FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:FAKHOURY
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:AQEEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN
Mailing Address - Street 1:4068 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-3900
Mailing Address - Country:US
Mailing Address - Phone:845-229-2123
Mailing Address - Fax:
Practice Address - Street 1:4068 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3900
Practice Address - Country:US
Practice Address - Phone:845-229-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily